Sources for Community Independent Living Services, Inc.

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

CS014 Issued in AR

Legal business name

SOURCES FOR COMMUNITY INDEPENDENT LIVING SERVICES, INC.

Practice address

1918 N Birch Ave
Fayetteville, AR 72703-2408

Phone

(479) 442-5600

NPI assigned

Feb 16, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jim Mather

Title

Executive Director

Phone

(479) 442-5600

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gerald Howard Funkhouser Jr., CRC CSM

  • Case Manager/Care Coordinator
  • Fayetteville, AR
  • NPI 1366617821
  NPD (past)
• Kirstin Marie Morgan, M.S., C.R.C.

  • Case Manager/Care Coordinator
  • Fayetteville, AR
  • NPI 1851566871
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1043583412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1918 N BIRCH AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 N BIRCH AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032408",
            "telephone_number": "479-442-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCES FOR COMMUNITY INDEPENDENT LIVING SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-16",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "MATHER",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "479-442-5600"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "AR",
            "license": "CS014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164857798",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Sorrells, R.PH.
• Lisa Sotomayor, LMT NH
• Soul Purpose, LLC
• Fatim Soumah
• Sound Solutions Inc
• Barron Tracy South, MS, PT
• Southern Home Care Services, Inc.
• Alison Lynn Spagnolo, DPT
• Eric Christopher Spahn, PHARM. D.
• William E Spaine, PSY.D.

• Case Management Agency in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Case Management Agency in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.